Project SHORT: Grad School Mentor Form
Sign in to Google to save your progress. Learn more
First and last name *
E-mail address (please check for accuracy)   *
What are your pronouns? *
We are collecting the following information for two purposes: To better match you with a mentor with shared life experiences, and to assess our goals for reaching underrepresented applicants. These data will only be seen by Project SHORT committee members. Aggregate counts and percentages may be released, but will not be attached to any identifying information. You may select "prefer not answer" to any questions you do not wish to answer.
In which country do you currently reside? *
In which state do you currently reside? *
Undergraduate university (please include full name, no acronyms) *
How would you categorize your undergraduate institution? *
What was your undergraduate major(s)? *
What is your current status? *
What institution are you currently at? Institution is broad - can be a university, company, etc. *
What is the discipline of your doctorate degree? Please choose the closest option. *
Is there is a secondary area in which you are also comfortable mentoring applicants?
What are your research interests? Please use keywords.
Do you identify as any of the following? (Please check all that apply – but do not feel obligated to disclose anything you are not comfortable sharing.) *
What race/ethnicity(ies) do you identify with? Check all that apply. *
What is your gender? *
Do you have any physical or mental disabilities? *
How would you define your family of origin's class? *
How would you define your current class? *
Why are you interested in joining the Project SHORT team (please limit to 150 words)? *
How did you hear about us (check all that apply)? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Project SHORT. Report Abuse